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06/03/2004 10:24 2094671118 AGE STOCKTON PAGE 01/0 <br /> EHD 1-0r,NUMB <br /> GATE RECENED 0 SAN JOAQi7tN COUNTS <br /> RECu\4 ED ENVIRONMENTALdHEALTH DEPARTivH NT <br /> LS II J 304 E Weber Ave 3 Floor Stockton, CA 95205 <br /> JUN 0 3 26�W9)468-3420 Fax: (209) 464-01.38 Web: www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> E p�p���7I Qak/dncP� �iJU/rzanlltPA�a Q <br /> APP#.it'S'ANT.`S �I Iy�7 BUSINESSlAGENCY: <br /> ADDRESS: rJ�J (r/S <br /> PHONE:- Ot D�— 7 k 7—I0D!�OFACSIMILE: <br /> r <br /> TENTATIVE'APPOINTMENT DATE: -77)65JE5 LIUl1 Q nme: •7 <br /> (Please allow 10 business days from date of application submittal) -T A11.Cd M e 1qe KA2� <br /> /Aanyam <br /> CHECK BOX TO EXPEDITE REQUES -V, .00 FEE-REQUEST ROCS 5ED IN]BUSINESS DAYS JAP <br /> SIGNATURE OF APPLICANT DATE <br /> anment Use OrIN <br /> FILE ADDRESS UNIT <br /> so-•et <br /> (n <br /> C <br /> 5 D � ❑ Unit 1 <br /> Sip y <br /> A� i. sueee f -rA- <br /> Cky Unit 2 /!/G�17����L,\ <br /> treat D a G () C�V <br /> m e� L Unita <br /> (� Set trWe 0 <br /> 7 sy,� ,E, n cx C ° unit <br /> o <br /> B. S(mM <br /> 1n0Ala ►y ❑ Unit 5 <br /> Ic, swee Ix a C L— <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES (7) 7 § <br /> fNDERGROUND TANK(UST)CLEANUP SITE ILOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTEHCTHER CLEANUP SITE(NON-LOP) 4 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> NDERGROUNDTANK(MONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKGTRFJITMENTPLANT <br /> IER ED pERMITMD FACILITY O MOTEL/HOTEL +�O.�P�U�MPER YRUCKIYARDlCHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA > LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate bOX(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> G. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business da <br /> CONFIRMED APPOINTMENT DATE TIME ` } <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Ernnn'ai'� <br />